Search tips
Search criteria 


Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2006 October 1; 56(531): 749–755.
PMCID: PMC1920714

How are different types of continuity achieved? A mixed methods longitudinal study

Mary Boulton, BA, PhD, HonMFPH, Director of Research
School of Health & Social Care, Oxford Brookes University, Oxford
Carolyn Tarrant, BSc, Research Associate
Clinical Governance Research and Development Unit, Department of General Practice and Primary Health Care, Leicester
Kate Windridge, BSc, PhD, Research Fellow
Department of Health Sciences, University of Leicester, Leicester
Richard Baker, MD, FRCGP, Professor of Quality in Health Care
Clinical Governance Research and Development Unit, Department of General Practice and Primary Health Care, Leicester
George K Freeman, MD, FRCGP, Emeritus Professor of General Practice



In the context of developments in healthcare services that emphasise swift access to care, concern has been expressed about whether and how continuity of care, particularly interpersonal continuity, will continue to be achieved.


To explore how patients regard and use primary care services in relation to continuity of provider and access to care, to identify factors that promote or hinder their success in achieving their preferences, and to describe what this means for how different types of continuity are achieved.

Design of study

Longitudinal, mixed methods.


Community in London and Leicester


Purposive sample of 31 patients recruited from general practices, walk-in centres and direct advertising. Data collection involved in-depth interviews, consultation record booklets completed over 6 months and general practice records for the year including the study period. Data were analysed qualitatively.


Four patterns were identified in the way patients used primary care. These were shaped by their own preferences, by the organisation and culture of their primary care practices, and by their own and their provider's efforts to achieve their preferences. Different configurations of these factors gave rise to different types of continuity. Patients were not always able to achieve the type they wanted. Patients with apparently similar consulting patterns could experience them differently.


Within a programme of modernisation, policies that promote a commitment to meeting the preferences of different patients with flexibility and understanding are most likely to provide continued support for interpersonal and other types of continuity of care.

Keywords: access to health care, continuity of care, interpersonal relations, mixed methods, physician patient relationship, qualitative research

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners